Complications related to vascular closure devices (VCDs) remain relatively common after transcatheter aortic valve implantation (TAVI), while the optimal suture-based strategy remains a subject of debate. This systematic review and meta-analysis aim to evaluate the efficacy and safety of single versus double Perclose VCD in patients undergoing transfemoral TAVI. A literature search was conducted across PubMed, Scopus, and Cochrane databases to identify appropriate studies. The primary outcome was technical success; secondary outcomes included vascular and bleeding complications, bailout interventions, and all-cause mortality. Seven studies (3940 patients) fulfilled the inclusion criteria. Technical success was comparable between the two strategies (relative risk [RR]: .89; 95% confidence interval [CI]: .64-1.22), while the single Perclose strategy was associated with a lower risk of major vascular complications (RR: .61; 95% CI: .40-.92), major bleeding (RR: .28; 95% CI: .11-.73) and bailout surgical interventions (RR: .45; 95% CI: .24-.84). There were no differences in minor vascular complications and all-cause mortality. Stepwise closure with the upfront single Perclose strategy demonstrated comparable technical success and a more favorable safety profile regarding major vascular complications and bleeding compared with the double Perclose strategy. Additional randomized controlled trials are essential to validate these findings.

Acute myocardial infarction is a major cause of mortality in individuals with obstructive airway disease. The impact of inpatient care quality following non-ST elevation myocardial infarction (NSTEMI) on long-term mortality among those with chronic obstructive pulmonary disease (COPD) and asthma remains poorly understood. We analysed 499 318 adults with NSTEMI from the Myocardial Ischaemia National Audit Project registry between 2005 and 2019, linked with Hospital Episode Statistics for airway disease diagnosis and Office for National Statistics data for mortality outcomes. Inpatient care quality was measured using the opportunity-based quality-indicator (OBQI) score. Long-term outcomes were evaluated using multivariable Cox regression and Kaplan-Meier analyses. Individuals with COPD and asthma received lower quality of care (OBQI score: no airways disease: 83.5 vs COPD: 78.1, asthma: 80.8, P < .001). Percutaneous coronary intervention was less frequent in COPD patients (22%) than in those without airway disease (30%) or with asthma (31%), P < .001. COPD was associated with higher 10-year mortality (hazard ratio [HR]: 1.58, 95% CI 1.56-1.60), whereas those with asthma had lower risk (HR: 0.97, 95% CI 0.95-0.98). COPD was associated with increased adjusted cardiovascular mortality (sub-distribution HR: 1.89, 95% CI 1.84-1.95). Individuals with COPD received lower-quality inpatient care and fewer coronary interventions, which was associated with higher long-term mortality.

Outcomes after intervention for chronic venous insufficiency (CVI) is difficult to predict. This study aimed to develop machine learning (ML) models to predict 90-day clinical improvement after varicose vein surgery and identify key factors. This retrospective multicenter study included patients with CVI undergoing first-time varicose vein surgery between 2014 and 2024. CVI was classified according to the Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) classification and Venous Clinical Severity Score (VCSS). Clinical improvement at 90 days was defined as any decrease in CEAP stage. Three ML classifiers (Logistic Regression, Random Forest, and XGBoost) were trained to predict improvement, with nested stratified cross-validation and undersampling to address class imbalance. In total, 4015 patients were included and 87.6% showed clinical improvement at 90 days. Non-improved patients were older, had higher body mass index (BMI), and higher baseline VCSS and CEAP scores. Random Forest achieved the best overall performance, with an accuracy of 80%, recall of 75%, and F1-score of 0.49 to predict the lack of improvement, indicating effective identification of at-risk individuals. Key predictors included baseline CEAP and VCSS scores, BMI, age, and surgical variables. The overall predictive performance of ML was modest, but the models highlighted patients at risk of poor outcomes.

The ratio of red cell distribution width (RDW) to albumin (RAR) has been shown to correlate with poor prognosis in patients with various diseases. However, the relationship between RAR and cardiovascular disease (CVD) remains inadequately elucidated. We conducted this study using data from 12 755 participants in the National Health and Nutrition Examination Survey (NHANES) 2007 to 2018. Multivariable regression analysis and subgroup analysis were conducted to analyze the potential relationship. In this study, RAR was significantly and positively associated with CVD mortality (hazard ratio [HR] = 1.99, 95% CI = 1.81-2.19, P < .001), total CVD (odds ratios [OR] = 1.42, 95% CI = 1.31-1.54, P < .001), congestive heart failure (CHF; OR = 1.70, 95% CI = 1.52-1.90, P < .001), coronary heart disease (CHD; OR = 1.18, 95% CI = 1.05-1.33 P = .006), and myocardial infarction (MI; OR = 1.32, 95% CI = 1.18-1.47, P < .001). Subgroup analyses confirmed the robustness of the findings. Our findings demonstrate significant and independent associations of RAR levels with CVD mortality and specific CVD. As a straightforward, cost-effective, and readily accessible metric, RAR has the potential to offer novel insights into CVD risk assessment.

Epilepsy, antiepileptic drugs (AEDs), and adjuvant treatments may correlate with the development of subclinical atherosclerosis. We performed a systematic review and meta-analysis to evaluate the effects of epilepsy, AEDs, and adjuvant treatments on the structural and functional markers of subclinical atherosclerosis represented by carotid intima-media thickness (cIMT), epicardial adipose tissue thickness (EATT), and flow-mediated vasodilation (FMD). Weighted mean differences (WMD) and corresponding 95% confidence intervals (CIs) were analyzed. Thirty-one studies were included with 9 different outcomes. Compared with controls, the epileptic patients demonstrated significantly thicker cIMT (WMD [95% CI] = 0.063 [0.045-0.080], P < .001) and EATT (WMD [95% CI] = 1.985 [1.630-2.341], P < .001). There was no significant difference in FMD (P > .050). Moreover, cIMT was still thicker in the epileptic patients on old AEDs compared with those on new AEDs (WMD [95% CI] = 0.038 [0.000-0.076], P = .050), on multi-AEDs compared with on mono-AEDs (WMD [95% CI] = 0.025 [0.021-0.029], P < .001), and on enzyme-inducing AEDs compared with on non-enzyme-inducing AEDs (WMD [95% CI] = 0.027 [0.006-0.047], P = .011). No significant differences in cIMT were detected in any comparison of adjuvant treatments (ketogenic diet, Atkins diet, and folic acid supplements; all P > .050). Epilepsy and AEDs, especially old AEDs, multi-AEDs, and enzyme-inducing AEDs, could exacerbate the development of subclinical atherosclerosis. Early prevention as well as timely intervention for subclinical atherosclerosis should be considered for these patients.

Contrast-induced nephropathy (CIN) is a serious complication following percutaneous coronary intervention (PCI). The Renal dysfunction, Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus and prior Stroke R2CHADS2 score, originally developed for thromboembolic risk assessment, has recently been proposed as a predictor of CIN and major adverse cardiovascular events (MACE). The present study aimed to evaluate the predictive value of the R2CHADS2 score for CIN and long-term MACE in STEMI patients undergoing primary PCI (pPCI). A total of 1204 STEMI patients were included in this retrospective study. Patients were categorized into 3 risk groups based on their R2CHADS2 scores. CIN incidence was significantly higher in the high-risk group (37.1%) compared with the moderate (13.6%) and low-risk groups (5.5%; P < .001). Hemodialysis was required in 14.3% of high-risk patients (P < .001). MACE occurred in 49.3% of the high-risk group, 22.1% of the moderate-risk group, and 12.9% of the low-risk group (P < .001). These findings suggest that the R2CHADS2 score can predict CIN and adverse cardiovascular outcomes in STEMI patients undergoing pPCI.

Peripheral Artery Disease (PAD) with Chronic Limb Threatening Ischemia (CLTI) is a severe condition at risk of amputation, and often conventional surgical and endovascular procedures and/or medical therapy are insufficient. The present review considers current knowledge regarding autologous cell therapy and regenerative medicine for PAD with CLTI. We evaluated cell-based therapies in the recent literature, that are pivotal in treating vascular disorders by promoting angiogenesis, vascular restoration, and tissue regeneration; furthermore, we provided an overview of the relevant main clinical studies. Clinical conditions and risk factors of patients correlate with the performance of autologous cell-based therapies and the probability of success. Nevertheless, the current evidence indicates that these therapies are promising, necessitating further research. Autologous cell therapy and regenerative medicine can offer additional support for treating PAD with CLTI. These advanced techniques are becoming more tailored and substantial for their application in clinical practice. Personalized Medicine represents a contemporary paradigm that calls for consideration of individual patient's clinical conditions, risk factors, and biomarkers.